Common use of Coding Requirements Clause in Contracts

Coding Requirements. ‌ 3.16.3.1 The MCO must use the most current version of the following coding sources: (1) Diagnosis and inpatient hospital procedure codes obtained from the International Classification of Diseases, Clinical Modification ICD-10-CM/PCS coding requirements on claim and encounter data submissions; (2) Procedure codes obtained from Physician’s Current Procedural Terminology (CPT) and from CMS’ Health Care Common Procedure Coding System (HCPCS Level 2); (3) American Dental Association current dental terminology codes as specified in Minnesota Statutes, §62Q.78; (4) National Drug Codes; and (5) Current local home care codes including units of service. 3.16.3.2 Neither the MCO nor its Subcontractors may redefine or substitute these required codes. 3.16.3.3 National Provider Identifier (NPI) and Atypical Provider Types. The MCO shall use the NPI for all Providers for whom CMS issues NPIs. For certain Providers of Atypical Services, the MCO shall use the STATE-issued UMPI.

Coding Requirements. ‌ 3.16.3.1 The MCO must use the most current version of the following coding sources: (1) Diagnosis and inpatient hospital procedure codes obtained from the International Classification of Diseases, Clinical Modification ICD-10-CM/PCS coding requirements on claim and encounter data submissions; (2) Procedure codes obtained from Physician’s Current Procedural Terminology (CPT) and from CMS’ Health Care Common Procedure Coding System (HCPCS Level 2); (3) American Dental Association current dental terminology codes as specified in Minnesota Statutes, §62Q.78; (4) National Drug Codes; and (5) Current local home care codes including units of service. 3.16.3.2 Neither the MCO nor its Subcontractors may redefine or substitute these required codes.codes.‌ 3.16.3.3 National Provider Identifier (NPI) and Atypical Provider Types. The MCO shall use the NPI for all Providers for whom CMS issues NPIs. For certain Providers of Atypical Services, the MCO shall use the STATE-issued UMPI.

Coding Requirements. ‌ 3.16.3.1 The MCO must use the most current version of the following coding sources: (1) Diagnosis and inpatient hospital procedure codes obtained from the International Classification of Diseases, Clinical Modification ICD-10-CM/PCS coding requirements on claim and encounter data submissions; (2) Procedure codes obtained from Physician’s Current Procedural Terminology (CPT) and from CMS’ Health Care Common Procedure Coding System (HCPCS Level 2);2);‌ (3) American Dental Association current dental terminology codes as specified in Minnesota Statutes, §62Q.78; (4) National Drug Codes; and (5) Current local home care codes including units of service. 3.16.3.2 Neither the MCO nor its Subcontractors may redefine or substitute these required codes. 3.16.3.3 National Provider Identifier (NPI) and Atypical Provider Types. The MCO shall use the NPI for all Providers for whom CMS issues NPIs. For certain Providers of Atypical Services, the MCO shall use the STATE-issued UMPI.